ACLr completed!

[Alison_NL]

Hey everyone

Sooo, the hospital just called, and my surgery is cancelled 
Apparently, they don't have a "piece of equipment" that they need for ACLr.  They're going to call back in 3 weeks.

Its so frustrating to be all ready (and even happy that I was getting it over with), and now being pushed ahead.  I don't even feel comfortable going there for my surgery now.. not if they aren't even properly equipped!  Clearly that hospital doesn't see very many ACL patients.

The way is see it is: 3 weeks postponed, that’s 3 weeks on the other end before I can get back to basketball, and now I have to write my final exams that I didn't prepare for.

Sorry for the rant.. I’m sure this has happened to a lot of you as well.  Although not having a "piece of equipment" is kind of discouraging, don’t you think?

alison

[Kai]

That totally sucks!   You'd think that they knew they would need that thing ....

[Nola]

It is okay to rant here.  

I would not discredit the hospital itself too much though, the problem is that you are 16 and going to a Children's Hospital.  It is much more important that the surgeon you are seeing is equipped with the experience and savvy to deal with your particular situation. You are right in the assumption that they probably don't do very many of them.  I would talk it over with my parents and then discuss it with the OS that because you are 16 it is possible to be done in an adult facility more versed with the procedure.  In the US all hospitals here have to have anesthesiologists capable of inducting anesthesia on children.  Anesthesia is the issue with where you have your procedure done... not the size of the equipment in surgery.  Obviously if you were 3 years old that would be an issue, but you are not!  See if your parents and the OS would consider doing you in an adult hospital... Let us know!

[Annika]

I'll back Nola here, my OS did a 15year old girl two days before med - She was physically quite adult and very strong (yet another prorider) still she was only 15 and it was never seen as a problem.

[enzo]

Bad luck Alison. What a pain. In the long term you won't think back to this at all. In fact it will give you a bit more time to prepare - just trying to be positive!

I think Nola's right - v good suggestion.

I just wanted to remind you of a reply to a post which I think jb knee geek wrote in which he was talking about the importance of your OS having a lot of experience of doing aclr surgery.
I think jb knee geek wrote something along the lines of you want someone who does a minimum of about 30 or 40 per year. That sounds a good guideline to me. Your OS sounds like he/she is a general orthodpaedic surgeon in a children's hospital. You need an OS who specialises in knees

ACLR is a very succesful surgery but it's also apparently pretty technically demanding for the surgeon. The surgeon needs to be very up to date with the latest aclr techniques, tunnel placement, fixation methods, rehab protocol etc. It's just not worth trusting someone who's been taught the technique during their training but now only does the occasional acl surgery. It would probably be ok but is too much of a risk IMHO. I think you might be right that the lack of a piece of equipment suggests they possibly don't do aclr very often.

It's pretty impossible to know how good your OS is at aclr but I had a similar concern with my OS so I just asked him (as subtely as possible!), "Hey Mr Surgeon, everyone seems to be getting this injury these days don't they. Just how many acl surgeries do you end up having to do each year?". He replied "On average, 2 per week" and that re-assured me somewhat.

With that said, for all me know, this OS might be the best aclr surgeon in Canada!

enzo

[jessie23]

You have a good chance to have it done in an "adult hospital", most hospitals will have a pediatric wing that you will be placed on since you are under 18.  The OS who did my aclr also performed elbow surgery on me when I was 6 and I was placed in the pediatric wing.
I hope it gets rescheduled soon, I know the waiting sucks. hang in there

[Alison_NL]

Thank you so much for all your words of encouragment!

I don't know if switching to the "adult hospital" would be possible, and if it was, I'd probably have to wait another year to get in.
So I can wait for a few more weeks, and just let my current OS do the surgery (who's done 4 in the past 2 years.. yet seems very confident, and shes a young surgeon.) Or I could try to get into see another doctor, which might not be possible and have to wait for another year.  To me, the second option doesn't seem that inviting because its important that I get back to basketball before my senior high school year is over if I have a chance to play varsity. 

I've heard a lot of good things about my current OS, such as shes the "up and coming surgeon" of our area, so I think I'll stick with her. I'll let you all know what I decide.

Thanks again for your words of wisdom!

[Kai]

I would not let anyone that does less than 50 ACLrs in a year come near my knee.

[enzo]

I'm with Kai on this one. I wouldn't let this OS do my knee surgery.
It's true on the one hand that she might be an excellent OS even though she's only done a few acl surgeries. After all the best surgeons have to start somewhere. But you have no way of knowing that.
It's just not a risk I would take. Even if it meant waiting until next year I would want a much more experienced acl surgeon.

I had 3 choices before I went for my aclr:-
1st choice: OS(knee specialist) in private sports injury clinic £5000
2nd choice: OS(knee specialist) in general hospital £free
3rd choice: OS(general orthopaedics) in general hospital £free

I ended up with my 2nd choice which is probably what most people end up with. I was very happy with it.
I couldn't have my 1st choice due to money/insurance reasons (ie. a lack of).
As I say I think the 3rd choice is too much of a risk. I just asked a few questions to make sure I got an OS who fitted in as my 2nd choice rather than my 3rd. That's roughly how it works in the UK. I can't comment about Canada obviously.

If I could turn back the clock back a few years to when i still had a chance of a professional sports career, I would have somehow found a way to have my 1st choice (maybe robbing a bank or something!).

I sympathise that you've got a small stumbling block here.
You could maybe just say (very politely!) to this OS that you're a bit concerned about her lack of acl experience. She might be able to re-assure you in some way.

Good luck with whatever you decide.

enzo

[Nola]

It is a really tough call.  Looking from the outside in it is easy to agree with Kai and enzo, but there is also the consideration of patient doctor trust and confidence.  It is a touigh call, and I don't envy to be in your shoes right now.

There is a definite learning curve for all surgeries, knees are no exception.  Good luck withyour decision which ever way you choose!

[poisson]

and just let my current OS do the surgery (who's done 4 in the past 2 years.. yet seems very confident, and shes a young surgeon.)

2 ACLR/year is still at the start of the learning curve - no way you let someone that that near your knee!
Been offline for a while, but if it's worth anything in reply to your original questions -
1. yes get a cryocuff if you can - it's a lot more user friendly than frozen peas. My cryocuff didn't arrive until D3 post op and I coped with frozen peas and ice packs but it is much harder to get the compression.
2. Early physio is

• get your leg straight (but don't actively extend your knee against gravity)
• work on lots of static quads
• work on bending it to 90 gently

[Alison_NL]

Hi everyone.

Thanks for your responses.  I looked into the "adult hospital" and they, under no conditions, accept patients under the age of 18.
So, I can either wait until I'm 18 (no way.. haha) or I can go ahead and get my surgery in a couple of weeks with my current OS.

As of now, I'm sticking with my current doctor.  I know you all feel that I shouldn't let an inexperienced OS near my knee, but I'm going to book an appointment to meet with her, and like enzo said, "subtly" ask her about her confidence with this surgery. Maybe she can reassure me in some way!

Thanks so much for you imput and support.

Alison

[Annika]

Hi Alison,

She may be young but she may also be experienced. Ask her where she did her knee training and how many ACLs she has made. Explain you are nervous and could she please tell you what she has done. Don't accept being 'fobbed off' but ask for straight answers. Normally a surgeon does improve with age but some on the other hand are quite good from a young age, especially in area's that interests them.

Good luck, Annika

PS - don't forget to get your PT - if your OS says you don't need it I would be very concerned about her ACL experience.

[Alison_NL]

Annika,

I will ask her about her experience, and I'm sure I'll get some straight answers.
She has talked a lot about the importance of physio. She said I'll start a couple days after my surgery.  I have what a lot of people consider the best PT in the province, so I'm in good hands there!

Alison

[jb-knee-geek]

Its so frustrating to be all ready (and even happy that I was getting it over with), and now being pushed ahead.  I don't even feel comfortable going there for my surgery now.. not if they aren't even properly equipped!  Clearly that hospital doesn't see very many ACL patients.

Hi Alison, I hate to add to your doubts about your current surgeon, but I'll support to the other excellent posters and your initial assessment. 4 ACL surgeries in 2 years seems light. You want experience, not confidence.

How is that you are not able to be seen by an ACLr experienced OS? This is a devastating injury for athletes, yet you are willing to let an inexperienced OS do the job. 

I understand that the availability of surgeons in your area may be difficult, it's worth taking the time to find a 2nd or 3rd opinion from the best.  Ask around the local university basketball programs for athletes who've gone through this.

What do your coaches and parents think about using the current OS?

IMHO, your best move is to get the best OS you can find (or afford), have ACLr, rehab hard, then see what sports you can handle. A return to hoops with your injury is a tall order, even for the best athletes. You don't seem to fall into that category.

The way is see it is: 3 weeks postponed, that’s 3 weeks on the other end before I can get back to basketball, and now I have to write my final exams that I didn't prepare for.

The idea is not to get ALCr done quickly, but correctly.

I hope this helps, my intention is to offer the bit of experience I've gained in the 5 years of researching my own ACLr, as others have done for me.

Best of luck to you.